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Vision Severity Rating Scale

Introduction

The Vision Severity Rating Scale (VSRS) has been developed to assist the teacher of the visually impaired in making recommendations for services to the visually impaired population in the state of Michigan.

A VSRS should be completed before every Individualized Educational Planning Committee meeting (IEPC). In addition, it is recommended that the Vision Severity Rating Scale be up-dated at the end of each school year.

Each of the eight categories listed on the Vision Severity Rating Scale Characteristic Worksheet is structured in terms of the impact on vision functioning as it relates to the student's educational program (core curriculum). When using the Vision Severity Rating Scale, criteria provided within each of the categories is not all inclusive and many criteria overlap from one severity level to the next. Additional factors may influence the selection of the severity level by the teacher of the visually impaired. Additional evaluations may be conducted to aid in the choice of severity levels.

Rationale

A committee consisting of teachers of the visually impaired throughout the state of Michigan and from Michigan School for the Deaf and Blind was formed to address the standardization of service delivery to the visually impaired population. The need for consistency when determining the educational needs of the visually impaired was voiced repeatedly. Other concerns frequently mentioned were:

• Frequency of services
• Caseload management
• Service delivery models
• Preparations of materials
• Teaching the use of tangible aids
• Modifications to the learning environment
• Visual skills evaluation

Each of the these concerns was discussed extensively. The VSRS is the result of these discussions.

Purpose and Development

The purpose of this manual is to define criteria and guidelines for using the Vision Severity Rating Scale (VSRS) with students identified as visually impaired. It is primarily intended for use with students in general education settings and may be applicable for some students with additional mild impairments. Further, it is intended to assist the IEPC in the selection of a vision service delivery model for existing as well as newly identified visually impaired students. The Scale will also be used to document change from one service delivery model to another for existing visually impaired students.

The VSRS consists of the following eight categories:

1. Functional Visual Status
2. Level of Vision (Medical)
3. Near Vision Acuity (Functional)
4. Reading Medium
5. Use of Tangible Aids/Low Vision Devices/Technology
6. Materials Preparation
7. Communication with Pertinent Individuals and Parents
8. Compensatory Skills

This scale is sequentially structured based upon a student's need for intervention by a teacher of the visually impaired, the core curriculum teacher's need for assistance, and the amount of time required for material adaptations. Each of the eight categories is structured in terms of impact of visual functioning as it relates to the student's educational program. The severity level descriptors within each category purposely overlap to some degree. To aid the teacher of the visually impaired in the selection of the level that is most characteristic of the visually impaired student, additional evaluations may be necessary.

Category Definitions

1. FUNCTIONAL VISION STATUS -- refers to the student's ability to independently apply visual skills to the core curriculum.
2. LEVEL OF VISION (MEDICAL) -- refers to the student's level of vision as reported by an eye care specialist.
3. NEAR VISION ACUITY (FUNCTIONAL) -- refers to the student's ability to use vision for near point tasks such as reading (i.e., Lighthouse Near Vision Test).
4. READING MEDIUM -- refers to the student's primary mode of receptive learning (i.e., Braille, print, print modifications, tape, or combination). See Appendix B for resources.
5. TANGIBLE AIDS/LOW VISION DEVICES/TECHNOLOGY -- refers to the student's need for/use of low vision devices and technology (specialized equipment) to facilitate maximum participation in the core curriculum.
6. MATERIALS PREPARATION -- refers to the estimated time needed by the teacher of the visually impaired to modify materials necessary for the student's participation in the core curriculum.
7. COMMUNICATION WITH PERTINENT INDIVIDUALS -- refers to the amount of time needed for communication with school personnel, parents, medical personnel, and agencies, regarding learning environment modifications necessary to ensure the visually impaired learner's maximum participation in the core curriculum.
8. COMPENSATORY SKILLS -- refers to life role orientation which emphasize disability related needs, including vocational, social, and personal management skills.

Functional Vision Status

When determining a student with a visual impairment's ability to independently apply visual skills to the core curriculum, results of the following assessments may be considered by the teacher of the visually impaired.

• Distance Acuity - The following are suggested distance charts at 10 or 20 feet. Indicate the type of lighting present in the school environment.
  • Lighthouse Flash Cards - Identification of three pictures used for younger students.
  • HOTV - Identification of four items used for younger students.
  • SOSH (Students of Optometry Serving Haiti) - This is a number chart and can be used for students able to recognize numbers.
  • Lighthouse Distant Acuity Card or Sloan - letter charts to be used to identify letters of the alphabet.
  • Feinbloom Low Vision Chart - a number chart that can measure up to 20/700.
• Near Point Acuity - Use of one of the following charts is recommended to screen near point acuity from a distance of 14-16 inches.
  • Lighthouse Near Acuity Pictures (apple, house, umbrella)
  • Lighthouse Near Acuity- Numbers
  • Lighthouse Near Acuity- Letters
  • SOSH Near Acuity Chart- Numbers
  • Sloan Test Reading Cards for Low Vision Patients
• Field Screening - If a student has a suspected field loss that has not been indicated by the eye care specialist, the following may be used to get a determination of field loss:
  • Informal Screening
  • Referral to eye specialist with statement of concern
• Fixation - The ability to look at or maintain gaze on the object or person. At first the child may fix for one or two seconds (a duration of 10-15 seconds is preferable).
• Shifting of Gaze - Shifting of visual attention from object (or person) to object (or person).
• Convergence - Eyes turn in simultaneously to focus on the approaching object.
• Scanning - A student's ability to coordinate head and eyes to systematically search for stationary objects in the environment.
• Tracking - The student visually follows a slowly moving target crossing midline, in a vertical, diagonal, horizontal, and circular pattern. Observe the student's eyes to determine if smooth eye movement is present.
• Saccadic Movement - Successive, sequential eye movements characterized by eye jumps--ability to shift gaze from one point to another as in reading a line of print and shifting from one line to another.
• Print Size - Using a variety of print sizes including the student's reading book, math book and a sample of the worksheets used in class, have the student read selected portions of the material. Record the following observations:
  • Size of print
  • Contrast of materials
  • Distance from materials when reading
  • Posture of student
  • Sustained reading time

See Appendix B for resources when completing a functional vision evaluation.

Model of Service Delivery

1. MONITORING -- The student is seen by a teacher of the visually impaired 1-5 times per school year. An annual functional vision evaluation may be conducted by the teacher of the visually impaired. Contact with the student, and pertinent individuals is intermittent throughout the remainder of the school year.
2. CONSULTATION -- The student receives services from the teacher of the visually impaired on a monthly basis and/or regularly scheduled times throughout the school year. The services can be direct, as with a vision evaluation, or indirect, such as consultations with pertinent individuals in which specific recommendations to appropriately modify the student's learning environments are suggested.
3. SUPPORTIVE -- The student is seen directly by the teacher of the visually impaired 1-2 times/week or 30-100 minutes per week. Functional vision evaluation is on-going throughout the school year. A minimal amount of preparation of materials or adapted aids might be needed. In addition, the teacher of the visually impaired may provide direct support to pertinent individuals, and make recommendations for changes in the student's learning environment.
4. INTEGRATED -- The student in this model requires direct service from the teacher of the visually impaired 3-5 times/week or 60-300 minutes per week. Preparation of materials (print modification, etc.) needs become frequent. The student might need to be introduced to some new tangible aids or new skills, i.e., multiplying on the abacus, keyboarding, or life skills. The teacher of the visually impaired provides regular communication to pertinent individuals regarding the student's needs.
5. INTENSIVE -- The student in this model is most likely to be one whose learning needs require intensive instruction 5 or more times/week or 180-360 minutes per week by the teacher of the visually impaired in order to facilitate academic growth and participation in the regular classroom. The student may be learning to use tangible aids and technology to facilitate communication in school work. Modifications in a student's learning environment (including frequent material preparation) and instruction in disability specific skills is on-going throughout the school year. The teacher of the visually impaired also has the responsibility of communicating regularly a student's visual strengths and weaknesses to all pertinent individuals.
6. COMPREHENSIVE -- the student in this model is one who needs almost total intervention (5+ times or 240-600 minutes per week) by the teacher of the visually impaired in the adaptations/preparation of materials. Many of the students in this model are learning/utilizing high technology. Consultation with school personnel may occur on a daily basis to facilitate maximum participation in the core curriculum. Ongoing communication with other pertinent individuals is necessary.

Professional Judgment Factors

On occasion the professional judgment of the teacher of the visually impaired can influence the selection of a service delivery model that has been determined by the Severity Rating. A choice of one or more of the Professional Judgment Factors on the Vision Severity Summary may be used to place a student at a higher or lower level Model of Service Delivery than indicated by the Severity Rating alone.

The use of the Professional Judgment Factors may be necessary when it appears that the Model of Service Delivery indicated by the Severity Rating does not reflect the true needs of the visually impaired student. Based upon the professional judgment of the teacher of the visually impaired, all factors which influence a modification of the Model of Service Delivery should be marked.

The following factors are to be considered:

1. Age of student
2. Availability of materials/equipment
3. Classroom teacher's need for support
4. Transition to a new school/building
5. Student cooperation
6. Parent concern
7. Attendance
8. Progressive condition
9. Home environment
10. . Visual field restriction
11. . Other (e.g., educational placement, additional impairments)

Remember, each of these factors may be either positive or negative and should be marked if modifying a service delivery rating.

DIRECTIONS FOR COMPLETING THE VISION SEVERITY CHARACTERISTICS AND VISION SEVERITY SUMMARY

This chart may be used three times.

1. Category names are listed vertically along the left hand side of the Vision Severity Characteristics Worksheet. Refer to definitions on preceding page as necessary.

2. Descriptors are listed horizontally for each category. The descriptors are listed sequentially in terms of severity, from mild to profound.

3. The numbers attached to each severity are considered part of a continuum. The specific number under each severity name is the numerical rating to be given for that severity. For example, under MILD, a numerical rating of 0, 1, or 2 is possible; while under PROFOUND, a numerical rating of 11 or 12 is possible.

4. For each category, mark the descriptor that best describes the visually impaired student. Place the appropriate severity number in the right hand column (Severity Score Column). Three columns are provided for evaluation on three separate occasions.

5. Total the right hand column to get a TOTAL SEVERITY SCORE.

6. Using the Total Severity Score, refer to the Vision Severity Summary to determine:

• Severity rating
• Frequency of service
• Total minutes of service per week.
• Model of service delivery

Record these findings in the Recommendations of Services section on the Vision Severity Summary.

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